Provider Demographics
NPI:1770366072
Name:SIU, REGINA PERRY (APRN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:PERRY
Last Name:SIU
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 BOSTON POST RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1888
Mailing Address - Country:US
Mailing Address - Phone:978-219-4040
Mailing Address - Fax:978-496-8386
Practice Address - Street 1:260 BOSTON POST RD STE 10
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1888
Practice Address - Country:US
Practice Address - Phone:978-219-4040
Practice Address - Fax:978-496-8386
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2347564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health